Over the course of a number of assessments carried out in walk-in medical clinics the Practice Enhancement Program (PEP) has identified a number of issues that have, up till now, reduced the effectiveness of the Program. The most important component of PEP has been, and remains, its ability to offer "enhancement" to the practices which it assesses. Management arrangements in some, though by no means all, walk-in clinics have thwarted this enhancement process.

Two major deficiencies that PEP has found are:

Failure to identify the patient's family doctor and to provide information to that family doctor about the walk-in clinic visit - this results in a deficiency of follow up and loss of continuity of care.

Failure to provide the components of the optimal care for chronic conditions for patients who make repetitive visits to a walk-in clinic and receive little or no care elsewhere. Some patients choose to make repetitive visits to a walk-in clinic, rather than establishing a relationship with a family doctor. Some physicians who work in walk-in clinics will make arrangements for repetitive visits by their patients.

This results in some patients not receiving the benefit of periodic full assessments and target organ review as recommended by practice guidelines. (There are patients who do not use a walk-in clinic only for episodic care and presumably assume that, because they are "going to the doctor regularly", they are getting comprehensive care. They are not.)

The majority of walk-in clinics that have been assessed have dealt very well with the two above noted issues. This is commendable. Furthermore it demonstrates that these deficiencies are not inherent in walk-in clinics and can be solved. Therefore, they can and should be dealt with properly in every walk-in clinic.

In some walk-in clinics the physician being assessed is virtually an employee of that clinic. These physicians may have little influence or input into clinic policy. On occasion the Practice Enhancement Program has noted, during a standard assessment, a number of issues that it has brought to the attention of the physician. If that physician had control over the practice, the PEP Committee would have expected that those issues would be the subject of enhancement with expectation of beneficial change.

PEP believes that an inability to make such change, as a result of circumstances beyond the physician's control, should not adversely affect that individual's personal assessment. Perhaps the most common such issue relates to policy on notification of the patient's family physician of his/her attendance at that walk-in clinic. Neither PEP nor the medical profession should accept the persistence of deficiencies of care.

In direct response to the concerns raised by the Practice Enhancement Program, a meeting was organized with representatives of the Practice Enhancement Program and its three governing bodies: the Department of Health, the Saskatchewan Medical Association and the College of Physicians and Surgeons of Saskatchewan. We reached an agreement that in such circumstances, the Practice Enhancement Program's mandate would be expanded to permit direct discussion of any such issues with the clinic's manager. This decision was unanimous and is backed by the legislative authority of the three parent bodies.

It is anticipated that this change will improve the Practice Enhancement Program's ability to carry out its mandate. The appropriate Bylaw amendment supporting this change will be available for review shortly. This extension of PEP's mandate responds to the recognition of a deficiency in the original mandate and is entirely consistent with the original and continuing purpose of PEP, which is to improve the care provided by all doctors for all citizens of Saskatchewan.